Objective To assess the outcome of the vaginoscopic approach to outpatient microhysteroscopy using a 2.5-mm semi-rigid hysteroscope without using a speculum, tenaculum or analgesia. Design A prospective observational study. Setting Outpatient hysteroscopy unit of a large district general hospital. Subjects 24 women referred to the outpatient hysteroscopy unit with abnormal uterine bleeding. Results A total of 24 women had vaginoscopic outpatient microhysteroscopy. Of the procedures, 20 (83.4%) were successful using the technique and four (16.6%) failed procedures occurred. Pain was not encountered during the procedure. Conclusion Outpatient hysteroscopy with a semi-rigid 2.5-mm microhysteroscope using the vaginoscopic approach is a well-tolerated and successful technique for the evaluation of abnormal genital tract bleeding.